Khairallah Moncef, Jelliti Bechir, Jenzeri Salah
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisiati.
Middle East Afr J Ophthalmol. 2009 Oct;16(4):225-38. doi: 10.4103/0974-9233.58426.
Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management.
对于所有葡萄膜炎患者,都应始终考虑感染性病因,并且应首先排除。鉴别诊断包括多种知名疾病,如疱疹、梅毒、弓形虫病、结核病、巴尔通体病、莱姆病等。然而,临床医生应意识到新出现的感染因子可能是全身性疾病以及眼内炎症的潜在病因。航空旅行、移民和商业全球化改变了传染病的传统地理分布模式,因此尽管不可能总是如此,但人们应该立足本地、放眼全球。本综述概述了几种与眼科医生相关的新发传染病的全身和眼部表现,包括立克次体病、西尼罗河病毒感染、裂谷热、登革热和基孔肯雅热。视网膜炎、脉络膜视网膜炎、视网膜血管炎和视神经受累与这些新发传染病有关。这些感染的诊断通常基于葡萄膜炎的类型、全身症状和体征以及特定的流行病学数据,并通过检测血清中的特异性抗体来确诊。系统的眼部检查显示出相当典型的眼底表现,可能有助于早期临床诊断的建立,从而实现及时、恰当的治疗。